Psychosocial adjustment in patients after a first acute myocardial infarction: the contribution of salutogenic and pathogenic variables. Israel Study Group on First Acute Myocardial Infarction

Psychosocial adaptation profiles in young and middle-aged patients with acute myocardial infarction: a latent profile analysis

AIMS

We sought to explore the latent classifications of psychosocial adaptation in young and middle-aged patients with acute myocardial infarction (AMI) and analyse the characteristics of different profiles of AMI patients.

METHODS AND RESULTS

A cross-sectional study was performed in 438 Chinese young and middle-aged patients with AMI. The investigation time was 1 month after discharge. Three different self-report instruments were distributed to the participants, including the Psychosocial Adjustment to Illness Scale, the Perceived Stress Scale, and the Social Support Rating Scale. The seven dimensions of the Psychosocial Adjustment to Illness Scale were then used to perform a latent profile analysis. All participants signed informed consent forms in accordance with the ethical principles of the Declaration of Helsinki. Finally, a total of 411 young and middle-aged AMI patients were enrolled. Three distinct profiles were identified, including the 'well-adapted group' (44.8%), 'highlight in psychological burdens group' (25.5%), and 'poorly adapted group' (29.7%). The influencing factors included stress perception, social support, occupational type, and marital status (P < 0.05).

CONCLUSION

The psychosocial adaptation of young and middle-aged AMI patients can be divided into three profiles. Clinical nurses can carry out individualized psychological interventions according to the characteristics of patients in different potential profiles to improve the psychosocial adaptation of patients and the prognosis of their disease.

Differences between Slovak and Dutch patients scheduled for coronary artery bypass graft surgery regarding clinical and psychosocial predictors of physical and mental health-related quality of life

BACKGROUND

Differences in health-related quality of life in coronary artery disease patients and associated factors between patients of central and western European descent are rarely investigated. We aim to test differences between Dutch and Slovak health-related quality of life, whether nationality predicted health-related quality of life and if standardised beta weights of health-related quality of life determinants differ across countries.

DESIGN

An observational multicentre study at university cardiac centres in the Netherlands and Slovakia.

METHODS

In 226 coronary artery disease patients, health-related quality of life was measured by the Short Form Health Survey 36, anxiety and depression were measured using the Hospital Anxiety and Depression Scale, and type D personality was assessed with the 14-item Type D Scale. Multivariate analysis was used to explore the effect of patient characteristics on the physical and mental component summaries. Estimates of each predictor's beta value of the physical and mental component summaries in the Slovak and Dutch patient sample were separately calculated using the Cummings criterion for comparison of two independent betas.

RESULTS

Stronger predictors of physical health-related quality of life in Slovak patients were educational level, current smoking, poor functional status, history of diabetes and amount of social support. In Dutch patients, only more symptoms of depression was a stronger predictor ( P<0.05). Regarding Slovak mental health-related quality of life, stronger predictors were educational level, current smoking and amount of social support. Female gender, history of myocardial infarction and more symptoms of depression were stronger predictors in Dutch patients ( P<0.05).

CONCLUSION

Descent and differences between both populations in determinants of health-related quality of life should be considered while planning care, follow-up, health education and rehabilitation.

Perceived needs for attaining a 'new normality' after surviving myocardial infarction: A qualitative study of patients' experience

Background: A comprehensive understanding of the various aspects of patients’ myocardial infarction (MI) experiences may help to guide these patients and their relatives through the many uncertainties they face and help them to stabilize their lives after the disruption they experienced.

Objectives: To explore MI patients’ experiences of life with MI, the challenges they face during the process of accepting their condition, and the setting and resetting of their personal goals.

Methods: Thirty semi-structured, individual interviews were conducted. The grounded theory method was used, and Atlas.ti qualitative data analysis software was used to facilitate the analysis.

Results: Three main themes and explanatory models emerged from the data analysis: a good adaptation – the ‘new normality;’ maladjustment – a continuous search for a ‘new normality;’ and perceived needs in the search for a new normality. Patients perceived several areas of need that they felt must be met before they could reach the state of a new normality. These needs included overcoming the anxiety of a possible MI recurrence; acquiring knowledge about MI in general and about ‘my MI’ in particular; the need for a timeline; for patience and steadiness; for both objective and subjective health status improvement; for taking control over the disease; and living within a supportive context.

Conclusion: When faced with a dramatic life event, most patients succeed in achieving a new normality in which they live changed but still satisfying lives. The needs experienced by patients when searching for a new normality may guide practitioners in leading patient-centred consultations.

KEY MESSAGES

Most MI patients achieve a new normality.

My physical identity is new: my body is different but still functional.

My personal identity is new: I am not the same as before, the disease is part of me, but I retain parts of my previous self.

Depression in Cardiovascular Patients in Middle Eastern Populations: A Literature Review

Cardiovascular disease (CVD) is increasing in Middle Eastern countries. Depression is associated with increased morbidity and mortality rates among cardiovascular (CV) patients. Early detection of and intervention for depression among CV patients can reduce morbidity and mortality and save health care costs. Public information on mental health care needs of Arab CV patients living in Middle East regions is scattered and limited. This literature review surveyed and summarized research studies to learn what is known about the relationship between depression and CVD in Middle Eastern populations. The information will raise awareness among health care professionals and policy makers regarding the clinical significance of depression in Arab CV patients. It might contribute to development of culturally appropriate and effective mental health care services. Multiple databases were searched and 60 articles were assessed, including studies that investigated depression in Arab CV patient populations, physiological mechanisms of depression-CVD comorbidity, and intervention strategies that affect CV risk in depressed Arab patients. We discuss the extent to which this issue has been explored in Arab populations living in Middle East regions and Arab populations living abroad. We recommend that more comprehensive and in-depth research studies be conducted with Arab cardiac patients to enable implementation of culturally appropriate and effective mental health care interventions.

Biopsychosocial predictors of coping strategies of patients postmyocardial infarction

Data from the Patients and Families Psychological Response to the Home Automated External Defibrillator Trial were used to examine the relationship between biopsychosocial variables and patients' coping strategies postmyocardial infarction. This study is the secondary data analysis of longitudinal observational study. A total of 460 patient-spouse pairs were recruited in January 2003 to October 2005. Hierarchical linear regression analysis examined biological/demographic, psychological and social variables regarding patients' coping scores using the Family Crisis Oriented Personal Evaluation Scale. Lower social support and social support satisfaction predicted lower total coping scores. Being younger, male gender and time since the myocardial infarction predicted lower positive coping strategy use. Higher anxiety and lower social support were related to fewer positive coping methods. Lower educational levels were related to increased use of negative coping strategies. Reduced social support predicted lower total coping scores and positive coping strategy use and greater passive coping style use. Social support from a broad network assisted with better coping; those living alone may need additional support. Social support and coping strategies should be taken into consideration for patients who have experienced a cardiac event.

Low psychological resilience is associated with depression in patients with cardiovascular disease

BACKGROUND

Psychological resilience is associated with an improved capacity to cope with chronic health challenges such as cardiovascular disease.

AIMS

The aim of this cross-sectional study was to examine the relationship between psychological resilience and symptoms of depression in a non-acute cardiac outpatient population.

METHODS

A total of 419 adult cardiac outpatients (288 men; mean±SD age 66.26±14.04 years) attending cardiovascular clinics completed the Sense of Coherence (SOC13) scale as a measure of psychological resilience and the Cardiac Depression Scale (CDS26) prior to their consultation.

RESULTS

The total SOC13 score (mean±SD 64.02±14.24, range 19-91) was within the moderate range. Older patients (⩾65 years) were significantly more resilient than those aged <65 ( p<0.01). Psychological resilience (SOC13) was negatively correlated with depression (CDS26) ( r=-0.79; p<0.001) and inversely associated with affective, cognitive and somatic symptoms of depression. Psychological resilience, particularly meaningfulness, accounted for more of the variance in affective features of depression than for somatic features.

CONCLUSION

These findings show that low psychological resilience was related to depression in this cohort of cardiac outpatients, particularly affective symptoms such as anhedonia and hopelessness. The SOC13 scale offers a complementary measure of psychological status that could be used to monitor, and possibly predict, patient coping and response to treatment throughout the cardiovascular disease trajectory.

Sense of Coherence and Health-Related Quality of Life among Patients Undergoing Coronary Artery Bypass Grafting or Angioplasty

BACKGROUND

Every year, 4 million people die from cardiovascular disease (CAD) in Europe. As many as 800,000 of them die before they reach the age of 65. The ischemic heart disease is also the most common cause of death in Finland. The invasive treatments of the CAD, coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) relieve symptoms and increase patient's health-related quality of life (HRQoL) in most of the cases. In this paper sense of coherence is discussed as related to health-related quality of life among CABG and PTCA patients in a one-year follow-up.

SAMPLE

The study sample consisted of consecutive male (N=439) and female (N=176) patients who were treated with the elective CABG or PTCA. The baseline data before the interventions were collected by structured interviews, the follow-up data by mailed self-administered questionnaires six and twelve months afterwards.

MEASURES

The sense of coherence was studied by using a 13-item SOC scale. HRQoL was measured by the 15D. It is a generic, multidimensional, standardized, self-administered instrument, which has both a profile and single index score property. The differences in both groups were defined by using T-tests. Follow-up outcomes were analysed by using analyses of variance for repeated measures.

RESULTS

Health-related quality of life increased in both groups during the follow-up. There was a correlation between health-related quality of life and sense of coherence in CABG and PTCA patients' group at baseline. The mean score of the 15D was lower in moderate sense of coherence tertile than in strong sense of coherence tertile in both groups. After six and twelve months the similar tendency existed in health-related quality of life and sense of coherence; patients who had poor or moderate sense of coherence had lower health-related quality of life than the patients with strong sense of coherence.

CONCLUSIONS

Sense of coherence was more stable among CABG patients than PTCA patients. In PTCA patients' group sense of coherence decreased during the follow-up time. In both patients' group the health-related quality of life increased statistically significant by 6 months. No significant change in health-related quality of life took place in either group from 6 to 12 months.

Israeli and Chinese partners of women with breast cancer: a cross-cultural view of marital issues

OBJECTIVE

Cultural nuances may influence the interface between the cancer experience and marital issues, specifically for the partner. Most of the literature has focused on the woman's narrative or couple's adjustment to cancer in general. The purpose of this study was to describe and compare the marital relationship, sexuality, and marital adjustment of Israeli and Chinese husbands of women with breast cancer and the discussion of the health-care team concerning these issues.

METHODS

A convenience sample of 50 Chinese and 50 Israeli men, ages of 28-79 years, completed components of the Psychological Adjustment to Illness Scale, the Locke Wallace Adjustment Scale, and a background questionnaire.

RESULTS

The majority of husbands were in their first marriage. The average time since diagnosis was 16.7 months. No significant difference was found between the two groups on issues of marital relationship. Significant differences were found between Israeli and Chinese husbands on sexual interest, pleasure, and performance (p<0.05). Israeli husbands reported a significantly higher level of marital adjustment as opposed to the Chinese husbands (p = 0.006). Marital adjustment for both groups was significantly related only to perceived quality of the relationship (p<0.03).

CONCLUSIONS

Significant cultural differences were found in sexuality variables with no differences discerned on marital relationship variables. Couple-based interventions for marital issues are a critical component of support for both partners. Culturally sensitive assessment and care of the spouse as well as the woman with breast cancer should be part of a holistic, comprehensive family care plan.

Sense of coherence--a determinant of quality of life over time in older female acute myocardial infarction survivors

AIMS

To determine the relationships between different sense of coherence levels and quality of life, and in older female myocardial infarction survivors; to investigate how socio-demographic, clinical characteristics, sense of coherence self-reported symptoms and function affect quality of life; and to determine whether sense of coherence and quality of life are stable during a six-month follow-up.

BACKGROUND

Myocardial infraction confers new physical and mental challenges. However, research on sense of coherence and other factors involved in maintaining physical, psychosocial and environmental aspects of quality of life in older female myocardial infraction survivors is scant.

DESIGN

Survey.

METHODS

A postal survey was conducted of 145 women, aged 62-80 years, three months to five years after myocardial infarction (T1), with a follow-up after six months (T2). Self-reported socio-demographic and clinical data and hospital medical records data were collected. The sense of coherence scale (SOC-29) and the World Health Organization Quality of Life Instrument Abbreviated (WHOQOL-BREF) were used.

RESULTS

We found a significant difference in quality of life between weak, moderate, and strong sense of coherence groups (p<0.001). Sense of coherence contributed to the level of all quality of life domains (p<0.001). Several clinical characteristics contributed to quality of life: (1) physical domain: comorbidities (p<0.001), previous myocardial infarction (p = 0.013), ejection fraction (p<0.011), length of hospital stay (p = 0.005) symptoms and function (p<0.001); (2) psychological domain: previous myocardial infarction (p = 0.031) and symptoms and function (p<0.001); and (3) environmental domain: education (p = 0.033) and symptoms and function (p = 0.003). On group level, both sense of coherence and quality of life were stable. Experiencing specific health changes (p<0.001), not major life events, influenced quality of life during the six-month follow-up.

CONCLUSION

Sense of coherence was an important stable determinant of quality of life domains in female myocardial infarction survivors. Although other factors were identified, further research is needed to elucidate additional determinants of quality of life.

RELEVANCE TO CLINICAL PRACTICE

These specific factors could guide clinicians in making treatment decisions that optimize the quality of life of their patients. Applying a salutogenic perspective through patient education may be important.

Sense of coherence as well as social support and network as perceived by patients with a suspected or manifest myocardial infarction: a short-term follow-up study

OBJECTIVE

To compare sense of coherence as well as social support and network as perceived by ischaemic heart disease patients at baseline and two weeks post-discharge in terms of age, sex, educational and marital status.

DESIGN

Multicentre study with a prospective short-term follow-up design.

SETTING

A university hospital, a central hospital and a district hospital in southern Sweden.

SUBJECTS

Consecutive sample of 246 patients with a suspect or manifest myocardial infarction.

MAIN MEASURES

The Lubben Social Network Scale (LSNS-R), the Medical Outcome Study (MOS) Social Support Survey and the Sense of Coherence Scale were included in a self-administered questionnaire and answered twice, together with sociodemographic variables.

RESULTS

Bivariate analyses indicated changes in social support (practical support increased in men and decreased in women; both P= 0.003) and social network (family network increased among >65 year olds; P= 0.001, men; P= 0.013, and women; P= 0.033, those with a low; P=0.017, and intermediate; P= 0.033, educational level, as well as those cohabiting; P= 0.0001), but did not reveal any difference in sense of coherence.

CONCLUSIONS

Sociodemographic variables have no influence on sense of coherence but do affect social support (i.e. practical support and social network, family). Ischaemic heart disease patients' short stay in hospital implies that the network outside the hospital has to assume responsibility, but at the same time it is important for health care professionals to have sufficient knowledge to be able to support the specific needs of patients and their family members.

The sense of coherence in hospitalized cardiac and cancer patients

The sense of coherence (SOC) is a measure of one's global orientation toward the world; it is the extent to which one perceives life as comprehensible, manageable, and meaningful. The study assesses the SOC of cardiac and cancer inpatients, and examines whether age, gender, race, education, and length of illness predict SOC. Participants comprise 172 patients (84 women, 88 men) at an urban hospital in the Northeastern United States, 122 with cardiac conditions and 50 with cancer. The mean age is 59.8. Results show that the SOC of cardiac and cancer patients is slightly lower than the general population. There are no differences in SOC between cardiac and cancer patients. Multiple regression shows that age and length of illness predict SOC (R=.26, R2=.07, p=.002); however because of the small effect size and collinearity, their exact contributions need further study. SOC does not vary according to gender, race, or education.

The effects of guided written disclosure on psychological symptoms among parents of children with cancer

This study examines whether structured writing about receiving a diagnosis and treatment for pediatric cancer reduces distress among highly distressed parents of children with cancer (PCWC). Eight PCWC completed measures of posttraumatic stress symptoms (PTSS) and depressive symptoms at two baselines, and again after writing, with 1-month gaps between assessments. Using a guided disclosure protocol (GDP), parents were asked to write about receiving the diagnosis first in a chronological manner, then to explicitly label their emotions at the time of diagnosis and explain the impact of the child's illness on their life. Finally, they were asked to reflect on current feelings, future coping ability, and personal growth. Although symptoms of distress did not change between baselines, significant reductions were found in PTSS from the first baseline to postwriting, but not in depression. This preliminary study suggests that the GDP may reduce PTSS in distressed PCWC.

Sense of coherence predicts change in life satisfaction among home-living residents in the community with mental health problems: a 1-year follow-up study

OBJECTIVES

There is a call for a further investigation of Sense of Coherence (SOC), the central concept in salutogenesis, and its relation to health and life satisfaction. No previous studies have investigated the utility of SOC versus mental symptoms for the prediction of life satisfaction among people with chronic mental health problems (MHP).

METHODS

The present study has a prospective design including a baseline assessment and a 1-year follow up. We recruited 107 adults from the community health care system. SOC was measured by the Sense of Coherence questionnaire, mental symptoms by the Symptom Checklist-90 revised and life satisfaction by The Quality of Life Scale (all Norwegian versions).

RESULTS

The results show that while SOC predicts change in life satisfaction (standardized beta coefficient for SOC was 0.39, P = 0.014), mental symptoms did not (standardized beta coefficient 0.00, P = 1.0).

CONCLUSIONS

These findings emphasize the importance of assessing factors that may explain differences in life satisfaction over and above mental symptoms among people with MHP. The results indicate that improving SOC among people with MHP might provide important opportunities for improving their life satisfaction.

Predictors of psychosocial adjustment in people with physical disease

AIMS

The purpose of this paper was to examine the demographic, medical and psychosocial variables that result in the deterioration of psychosocial adjustment in patients with physical disease, the meaning their illness has for them and their coping style.

METHODS

The study was carried out in inpatient clinics of the Istanbul Faculty of Medicine (n = 198). The following evaluation instruments were used: a semi-structured questionnaire, the Psychosocial Adjustment to Illness Scale-Self Report (PAIS-SR), the Meaning of Illness Questionnaire (MIQ), the Hospital Anxiety-Depression Scale, the Multivariate Perceived Social Support Questionnaire and the Ways of Coping Inventory (WCI). Variables to be related with psychosocial adjustment were analysed by using Forward Logistic Regression.

RESULTS

The mean age of patients was 36.9 (SD 12.9) (18-65), 55% of which were women, the average PAIS-SR score was 1.02 (SD 0.41) (0.7-2.26); 47% of the patients had poor adjustment scores. Univariate analysis showed that psychosocial adjustment was affected by having children (p = 0.02), anxiety, depression, locus of control, perceived social support (p < 0.001), information level about their illness and its treatment (p = 0.01), the subscales of WCI [escape-avoidance (p < 0.001), distancing (p = 0.002), planned problem solving (p < 0.001), positive re-appraisal (p = 0.02)]. The psychosocial adjustment of patients with respiratory or infectious illnesses or bone-muscle-skeletal disorders was even less (p = 0.03). All 33 items of the MIQ were found to have a significant impact on psychosocial adjustment (p < 0.001). According to the regression analysis, the best predictors of psychosocial adjustment were: depression (p < 0.001) and the meaning of illness for patient (p < 0.01).

CONCLUSIONS

Having a physical illness is an important stress factor. In providing assistance, a number of factors should be taken into consideration, including how the patient perceives his illness, the impact the illness has on the patient's life, and a determination of the degree of depression being experienced by the patient.

RELEVANCE TO CLINICAL PRACTICE

The study indicated some predictors in the assessment of psychosocial adjustment and care of patients with physical illness. In daily clinical practice, among the patients with physical illness, those with a negative perception of their illness and those who define depression should be given special attention for psychosocial support.

Changes in Health Related Quality of Life 3 months after an acute coronary syndrome

Background

The aim of the study was to identify the changes in Health Related Quality of Life (HRQL) 3 months after discharge from hospital, in patients who have had an acute coronary episode, and to determine the clinical and sociodemographic variables that explain those changes.

Methods

HRQL was assessed in 132 patients while they were admitted to the hospital and at 3 months after discharge, using the SF-36 health questionnaire. To identify the variables associated with the change, multiple linear regression models were constructed for two summary dimensions of the SF-36 (PCS and MCS) taking the change in the score of the dimension as dependent variable.

Results

There were no significant differences between the patients who completed the monitoring (n = 76) and those who were dropped out. After three months, a significant decrease was observed in the dimensions of physical functioning, general health, vitality, and Physical Summary Component (PCS). The variables revascularisation, age, and the interaction between previous history of coronary heart disease (CHD) and the presence of one or more risk factors explained 16.6% of the decrease in the PCS. The decrease in the PCS was 6.4 points less in the patients who had undergone revascularisation, 0.2 points less for each year of age, and 4.7 points less in the patients who had antecedents of the illness as well as one or more risk factors.

Conclusion

The dimensions most affected at three months after an acute coronary episode were those related to the physical component. Undergoing revascularisation improved the PCS in patients, but in the younger patients and those without personal antecedents or risk factors, the PCS was affected more, perhaps due to greater expectations for recovery in these patients.

Long-term mental health of women after a first acute myocardial infarction11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated

OBJECTIVES

To compare the long-term psychologic well-being and psychologic distress, after a first acute myocardial infarction (AMI), of women with those of men and those of a normative community sample of women and to examine the relation of sociodemographic, medical, and psychologic variables to the long-term psychologic well-being and psychologic distress of women.

DESIGN

Longitudinal study.

SETTING

Eight medical centers in central Israel.

PARTICIPANTS

Sixty-two women (age range, 30-65y) with documented first AMI.

INTERVENTIONS

Sociodemographic, medical, and psychologic data were collected before hospital discharge (T1). Psychologic well-being and psychologic distress were assessed 5 years after AMI (T2) with the Mental Health Inventory.

MAIN OUTCOME MEASURES

Hierarchical regression was used to examine the relations among the outcome variables, psychologic well-being, and psychologic distress at T2 and the predictors, sociodemographic, medical, and psychologic variables at T1.

RESULTS

Women had less long-term psychologic well-being and more psychologic distress after AMI than did men or the normative sample of women. Depression and concomitant medical problems were related to women's psychologic well-being; depression alone was related to their long-term psychologic distress.

CONCLUSIONS

Women with an AMI are more likely than men to have reduced psychologic well-being and increased psychologic distress. In addition, diminished mental health was related to medical and psychologic pathogenic factors.

Effects of a telephone counseling intervention on psychosocial adjustment in women following a cardiac event

OBJECTIVE

The purpose of this study was to test the effect of a post-discharge telephone counseling intervention on women's psychosocial adjustment following a cardiac event.

DESIGN

The study was a prospective, randomized, controlled trial.

PATIENTS

Women (n = 196) were recruited from 4 hospitals in Sydney, Australia, who were hospitalized for coronary artery disease: myocardial infarction, coronary artery bypass grafts, coronary angioplasty, or stable angina. Women were randomized to usual care (n = 103) or telephone counseling (n = 93) and were 67 years of age (range 34-92). The majority had not completed high school (92%) and were not employed (84%).

OUTCOMES

Psychosocial adjustment was measured by the Psychosocial Adjustment to Illness Scale and the Hospital Anxiety and Depression Scale the day before hospital discharge and 12 weeks postdischarge.

INTERVENTION

Individualized information and support, was designed to promote self-managed recovery and psychosocial adjustment, and began with an evaluation during admission and was followed up by telephone counseling at 1, 2, 3, and 6 weeks after discharge.

RESULTS

The intervention had no effect on psychosocial adjustment (F[1,182] = 0.06, P =.8), anxiety (F[1,182] = 0.15, P =.69) or depression (F[1,182] = 0.11, P =.74) at 12 weeks after discharge. Women made significant improvements during the 12 weeks on mean scores for psychosocial adjustment (F[1,182] = 58.37, P =.00), anxiety (F [1,182] = 74.58, P =.00) and depression (F[1,182] = 14.11, P =.00). The predictors of poor psychosocial outcomes for women included being less than 55 years of age, being unemployed or retired, having poor psychosocial adjustment to illness at baseline, having readmission, or experiencing a stressful, personal event during follow-up.

CONCLUSIONS

Women at risk for poor outcomes following hospitalization for a cardiac event can be identified (ie, women less than 55 years of age, unemployed or retired, poorly adjusted to their cardiac illness, or readmitted to hospital within 12 weeks of a previous cardiac admission), but an effective intervention to enhance psychosocial outcomes remains to be established.

The relationship between quality of life, sense of coherence and self-esteem in persons after coronary artery bypass graft surgery

We examined the contribution of Antonovsky's sense of coherence in explaining the variance of quality of life (QOL) in 84 patients 1-2 years following coronary artery bypass graft surgery. The hypothesis was: after controlling for variables related to poor health vulnerability, perceived support, self-esteem, and chronic illness trajectory instability and work, the addition of sense of coherence will significantly add to the explained variance of quality of life. The first two variables explained 49% of the variance of the QOL scale. Adding perceived social support, self-esteem and sense of coherence increased explained variance to 64%, 69%, and 75%, respectively. These findings supported our hypothesis.

Cultural aspects of adjustment to coronary heart disease in Chinese-Australians: a review of the literature

BACKGROUND

The burden of illness associated with Coronary Heart Disease (CHD) has determined this as a key focus for research at a basic science, individual and population level. Although considerable research has been conducted on specific aspects of the experience of CHD, such as anxiety or depression, there is a lack of research investigating the global aspects of the illness experience from the individual's perspective. Furthermore, there is a paucity of research examining the cross-cultural experiences of patients from Non-English Speaking Backgrounds (NESB). Given the multicultural nature of Australian society, and that health and illness are culturally constructed experiences (Manderson 1990), it is important to include the perspectives of people from minority cultures in health related research in order to provide culturally sensitive and appropriate health care and information during an illness. Further, the potential to prevent and modulate the course of CHD, by strategies such as smoking cessation and lipid management, mandate a health promotion agenda based on equity and access for all members of society.

AIMS

This article discusses cultural aspects of CHD in relation to nursing and allied health care during the recovery phase of an acute cardiac event. It reviews the research that has been conducted in this area, focusing on the Chinese-Australian population.

LITERATURE SEARCH

The CINAHL, MEDLINE, FAMILY (Australian Family and Society Abstracts Database), PsychINFO, and Multicultural Australian and immigration Studies (MAIS) databases were searched, identifying literature published from 1982. Keywords used were Chin* (Chinese, China), Asia* (Asia, Asian), experience, adjustment, psychological, heart, coronary, cardiac, health and services. Reports not written in English were excluded. Australian Government reports were also searched, as well as hand searching of nursing and medical textbooks. These searches resulted in over 1000 articles. However, only around 50 were relevant for this review.

IMPLICATIONS

Chinese-Australians are one of the fastest growing populations in Australia, and are at increased risk of CHD upon settling to Australia. Recommendations for future research and for the practice of nursing are provided.

Long-term mental health of men after a first acute myocardial infarction

OBJECTIVE

To evaluate the differential and independent impact of sociodemographic, medical, and psychologic variables assessed at hospital discharge on patients' short- and long-term mental health.

DESIGN

Longitudinal study.

SETTING

Eight medical centers in central Israel.

PARTICIPANTS

Male Israeli patients (N = 209; age range: 30-65 y) with documented first acute myocardial infarction (AMI).

INTERVENTION

Subjects were interviewed 3 times, once (T1) before hospital discharge, a second time (T2) at 3 to 6 months after discharge, and a third time (T3) at 5 years post-AMI. Sociodemographic, medical, and psychologic data were elicited at the first interview and completed with medical information in the files. Psychologic well-being and psychologic distress were evaluated by the Mental Health Inventory at the second and third interviews. These 2 outcome variables were compared with normative community data on these aspects of mental health.

MAIN OUTCOME MEASURES

Hierarchical regression was used to examine the relation between the independent variables, sociodemographic, medical, and psychologic variables, and the dependent variables, psychologic well-being and psychologic distress, at T2 and T3.

RESULTS

Depression, perceived health, sense of coherence, social support, and educational level at discharge predicted aspects of mental health 3 to 6 months and 5 years post-AMI. However, only psychologic distress differentiated between the research participants and the normative community sample of men.

CONCLUSIONS

A first episode of AMI appears to increase psychologic distress more than it decreases psychologic well-being both 3 to 6 months and 5 years post-AMI. Educational level and sense of coherence may serve as protective factors, whereas depression may foster vulnerability to distress and impaired psychologic well-being.